Provider Demographics
NPI:1568524361
Name:GORDON, ALICIA (DDS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 OLEARY CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-9513
Mailing Address - Country:US
Mailing Address - Phone:615-636-1140
Mailing Address - Fax:
Practice Address - Street 1:217 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-2812
Practice Address - Country:US
Practice Address - Phone:931-363-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice